Care Manager, Telephonic Nurse 2 - Remote, US

Humana Inc. Rogers , AR 72757

Posted 3 months ago


Humana Military, a wholly-owned subsidiary of Humana Inc. headquartered in Louisville, KY, partners with the Department of Defense to administer the TRICARE health program for military members, retirees and their families. For more than 20 years, Humana Military has strived to create better health outcomes and simplified experiences for millions of beneficiaries across the United States through TRICARE and other military healthcare programs. High-quality service, cost-effective platforms, and progressive approaches to care drive Humana Military to be a thought leader in the industry and an essential partner to the Government.


The Post Discharge Call (PDC) Telephonic Care Manager will be part of the Humana Military Care Management team; providing a comprehensive approach for post discharge care management. They will have personal interaction with beneficiaries to address clinical conditions identified through Predictive Analytics and post discharge needs important to the beneficiary. The PDC Care Manager will assist beneficiaries as they transition home from an acute setting to prevent unnecessary hospital admissions. As a Humana Military TRICARE - PDC Care Manager, you represent Humana Government Business (HGB) to administer the TRICARE benefit. You will coordinate with other members of the Care Management team, MTF UM staff as necessary and coordinate interventions with the beneficiary's physician. Performs all duties within the scope of her/his licensure.

The PDC Care Manager role includes the following:

  • Provide telephonic care guidance support to beneficiaries and their families to ensure post discharge instructions and follow-up care services are in place; according to the established plan of care.

  • Conduct assessments to identify gaps in care, eligibility for assistance and/or need for care management program or other referral services in collaboration with Humana Government Business.

  • Assess beneficiary needs and develop a personalized plan of care from the assessment findings; in coordination with the beneficiaries' physician and post discharge treatment plan.

  • Utilize Motivational Interviewing and solution-oriented approaches in communication delivery.

  • Identify Social Determinants of Health needs and/or community resources to provide services.

  • Ensuring in-home care delivery is in accordance with each beneficiaries' contractual program requirements and is high quality and complies with evidence-based clinical practice guidelines and TRICARE policy.

  • Thorough and timely documentation of initial and ongoing assessments and outcomes.

  • Close cases efficiently and appropriately as indicated by beneficiary completing established goals.

  • Ensure adherence to policies and performance standards in accordance with the URAC, TRICARE Operations Manual (TOM), TRICARE Provider Manual (TPM) or any other Defense Health Agency (DHA) directives.

  • Serve as a Humana Military liaison to TRICARE beneficiaries, guardians, personal care managers and providers.

  • Adhere to URAC standards, state and federal regulations and individual licensing boards.

  • Attend and participate in Care Management quality management/performance improvement activities.

  • Participate in professional development activities to include current principles, procedures, and knowledge domains of case management based on nationally recognized standards.

  • Performs all duties within the scope of her/his licensure and other tasks as assigned.

  • Our Department of Defense Contract requires U.S. citizenship for this position.

Required Qualifications

  • Bachelor's degree in Nursing or health related field.

  • Registered Nurse (RN) with current in state license.

  • Certification in Case Management (CCM).

  • Minimum of five (5) years' clinical nursing experience.

  • Experience with health promotion, coaching and wellness or prior managed care experience.

  • Proficient with Microsoft Office Excel & Word.

  • Excellent communication skills, verbal and written.

  • Excellent organizational skills.

  • Our Department of Defense Contract requires U.S. citizenship for this position.

  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation).

  • Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test.

Work at Home Requirements

  • Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

  • Must provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Preferred Qualifications

  • 3 plus years of telephonic care management/assessment and care coordination experience.

  • Prior TRICARE experience.

  • Bilingual - English, Spanish.

  • Direct or Indirect Military experience a plus.

Additional Information

The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours


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Care Manager, Telephonic Nurse 2 - Remote, US

Humana Inc.